SIRS

Dr. Jonathan Goodall, Hope Hospital

Powerpoint File

During the course of this talk I hope to outline the current management of patients with sepsis and systemic inflammatory response syndrome, including the use of newer therapies such as Activated Protein C. As a prelude to the talk I enclose a copy of the consensus definitions, to ensure that terminology does not get in the way of the messages I hope to deliver.

CONSENSUS CONFERENCE DEFINITIONS*

Systemic Inflammatory Response Syndrome (SIRS): 2 or more of the following:

• temperature > 38°C or < 36°C

• heart rate > 90 beats/minute

• respiration > 20/min or PaCO2 < 32mm Hg

• leukocyte count > 12,000/mm3, < 4,000/mm3 or > 10% immature (band) cells

Sepsis: SIRS resulting from a documented infection site (documented by positive culture for organisms from that site). Blood cultures do NOT need to be positive.

Severe Sepsis: Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion abnormalities include but are not limited to:

• lactic acidosis,

• oliguria,

• or an acute alteration in mental status.

Septic Shock: Sepsis-induced hypotension ( systolic BP < 90 mmhg or a reduction of >40 mmhg from baseline) in the absence of other causes for the hypotension and despite adequate. (Patients who are already receiving inotropes or vasopressors may not be hypotensive when perfusion abnormalities are documented).

Refractory Shock: Shock unresponsive to conventional therapy (fluid resuscitation, inotropes or vasopressors) within one hour.

*Data from the American College of Chest Physicians: Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 20:864-875, 1992